Table 1. Initial dosing UFH bolus and infusion Nomogram Bolus Dose (units/kg) Maximum Bolus (units) Initial Infusion (units/kg/hr) Rapid 80 10,000 18 Gradual None NA 12 3.3 Use heparin 25,000 units/500 mL D5W premixed bags 3.3.1 Other heparin concentrations are not allowed for use 4 UW Medicine Standard Protocols - Initiation Dosing. 1. Order standard heparin infusion with. Full dose heparin as a continuous IV infusion should be given for 5 to 10 days, followed by full dose heparin subcutaneously until term. Subcutaneous heparin should be given every 12 hours and adjusted to prolong the aPTT into the therapeutic range Heparin flush, 10 or 100 units/mL, is injected as a single dose into an intravenous injection device using a volume of solution equivalent to that of the indwelling venipuncture device Initial Maintenance Dose: Start heparin infusion (25,000 units/250 ml) using IV pump. Begin immediately after loading dose
Intravenous Therapeutic Dose Heparin Guidelines for Adults Therapeutic range for APTT ratio is 1.5 to 2.5 Indications for Therapeutic Intravenous Heparin Infusion include: As adjunctive therapy to fibrin specific thrombolytic (tenecteplase) in the treatment of ST Elevation Myocardial Infarction (STEMI Bolus dose Bolus dose for patients who have not received heparin within the last 6 hours. Preparation: Heparin Sodium Injection 1,000 units/ml. Dose: prescribe 5000 units as stat dose: 5mls of 1,000 units/ml. If bolus dose is not to be administered or was administered previously (e.g. Cath Lab), the prescriber should sign in the administration chart to signify this It is important to note that the most critical factor in reducing the risk of recurrent thromboembolism is reaching a therapeutic PTT within 24-48 hours. Traditional regimens that normally begin with 1000 u/hr are less likely to achieve this goal. See heparin overview below.. How to calculate the bolus dose and infusion rate for heparin, explained by a hospital pharmacist. Step-by-step process from a generic protocol order. Learn. Heparin resistance may be observed in patients with antithrombin deficiency, increased heparin clearance, elevations of heparin binding proteins, elevations of in factor VIII and/or fibrinogen and..
Loading Dose: Give heparin sodium by intravenous (IV) bolus approximately 75units/kg using actual bodyweight . If treating a severe pulmonary embolism give 10,000units IV bolu Standard heparin intravenous loading dose: 5,000 iu over 5 minutes Standard heparin continuous infusion: for a patient between 50 & 100 kg give 1,250 iu per hour initially = 30,000 iu per 24 hours If patient is <50kg or >100kg, calculate dose - 18 iu/kg/hr dose initially. For syringe pump using standard heparin 30,000 iu in 48m Forty-three patients were managed postoperatively with a low-dose intravenous heparin infusion (Maryland low-dose intravenous heparin infusion protocol: 8 U/kg/hr progressing over 36 hours to 10 U/kg/hr) beginning 12 hours after surgery and continuing until Day 14 after the ictus Heparin Infusion Protocols All heparin infusions use the standard preparation of Heparin 25,000 units in 250 mL of D5W (100 units/mL) Contraindication: Allergy to heparin
. You're supplied with a Heparin bag that reads 25,000 units/250 mL. The patient weighs 189 lbs. What is the flow rate you will set the IV pump at (mL/hr) IV Unfractionated Heparin Low Molecular Weight Heparin (LMWH) Treatment dose LMWHProphylactic dose LMWH E.g. Clexane 1.5 mg/kg s/c ODE.g. Clexane 40mg s/c OD Stop at least 24 hours prior to surgery Stop at least 12 hours prior to surgery IV Heparin Stop infusion 4-6 hours prior to surgery Prophylactic dose LMWH Treatment dose LMW
To Heparin infusion 1. If INR is subtherapeutic, start heparin infusion per protocol. 2. If INR is therapeutic or supratherapeutic, discuss with attending for optimal timing of heparin infusion initiation. Argatroban* heparin infusion within 2 hours of stopping nticoagulant after 2-4 hours of stopping argatroban. Do not give loading dose Heparin Injection must only be given by a doctor or nurse. How much is given Your doctor will decide what dose, how often and how long you will receive Heparin Injection. This depends on your condition and other factors, such as age, blood tests, method it is being given and whether or not other medicines are being given at the same time
Heparin infusion Warfarin If immediate therapeutic anticoagulation is desired: Overlap therapeutic heparin dose with warfarin for at least 5 days AND until INR is in therapeutic range for 24 hours. If immediate therapeutic anticoagulation is not desired: Initiate warfarin as clinically neede Intravenous unfractionated heparin Intravenous bolus dose (prior to commencing infusion) Administer a bolus of heparin sodium 80 units/kg(1) (maximum dose 5,000 units). For acute thrombosis a higher weight based bolus may be required. premix infusion bag of heparin 25,000 units in 250 mL normal saline)]
Heparin 5000 units by intravenous injection immediately before starting heparin infusion Instructions for the initiation and monitoring of unfractionated heparin intravenous infusions 1. Measure the APTT ratio (APTTR) at the start of therapy 2. Prescribe a 5000 units loading dose as a bolus IV injection by signing against the bolus prescription. Continuous Infusion Low-Dose Unfractionated Heparin for the Management of Hypercoagulability Associated With COVID-19 Show all authors. Matthew Li, PharmD, BCPS, BCCCP 1. Matthew Li . Department of Pharmacy, New York City Health + Hospitals/Queens, Jamaica, NY, USA View ORCID profil When heparin is given by continuous IV infusion and the dose is regulated with an appropriate clotting time test, the incidence of serious hemorrhage is reduced and therapeutic efficacy is assured. Few other medications with the toxicity of heparin that have been available for clinical use for so long have such a lack of uniformity in dosing and monitoring recommendations
Unfractionated Heparin Infusion Protocol Objective: Determine initial bolus dose and infusion rate i. Initial Bolus dose is indication specific, see tables below ii. Initial max infusion rate is indication specific, see tables below b. Total body weight (TBW as dry weight) will be used to calculate doses This page contains Clinical Practice Guidelines for the administration of Standard Heparin infusions, systemic lytic therapy and the management of a blocked central venous access device. In addition, the Clinical Haematology department has developed guidelines to support clinician's management of warfarin and low molecular weight heparin (Clexane) Heparin resistance refers to situations where unusually large doses of heparin are required to achieve anticoagulation. This is generally defined as requiring >35,000 units per day of heparin to achieve anticoagulation (e.g., an infusion of more than ~25 units/kg/hour). There are three causes of heparin resistance
Heparin infusion rather than using the Heparin 5000 units in 5 mL solution . Q5. Not all patients will require a bolus dose of IV heparin sodium. The responsible Medical Officer must refer to the relevant protocol for instructions regarding bolus dose prescription. An IV bolus of heparin is given in conjunction with the initiation of the I Initial experience with these agents in the EPIC (evaluation of c7E3 Fab in the prevention of ischemic complications) trial demonstrated that administration of abciximab with standard dose heparin (10 000-12 000 U bolus plus 12 hour heparin infusion) and aspirin resulted in 35% relative risk reduction at 30 days but a three fold increase in major bleeding complications (10.6% in the. It may be reasonable to avoid resumption of heparin infusion until fibrinogen is over ~100-150 mg/dL. Overall, if the patient has a favorable response to thrombolysis (clinical improvement, weaning off vasopressors), then waiting longer before resumption of heparin may increase safety and reduce the likelihood of hemorrhage Heparin drip calculation bolus practice problems for nursing students and medical students using dimensional analysis: Dosage and calculations can be a chall..
Patients receiving heparin continuous IV infusion: Stop heparin immediately after administering the first dose of oral anticoagulant. Patients receiving heparin intermittent IV injection: Start oral anticoagulant 0 to 2 hours before the time the next dose of heparin was to have been administered Start heparin infusion at time when next dose of LMWH/SC agent is due dabigatran Stop LMWH/SC agent Start heparin infusion immediately after bivalirudin infusion is stopped. Consider renal function in making decision. LMWH/subcutaneous agents (enoxaparin, fondaparinux, dalteparin The rebolus dose NOT TO EXCEED the bolus dose of Heparin when performing the titrations. Rebolus doses will be rounded to the nearest 1000 units. 7. In the event that the infusion has been turned off for >60 minutes for a procedure, the NURSE is to SUSPEND orders in the electronic medical record (EMR) and the nurse is to document the time when th Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for the initial treatment of venous thromboembolism. Cochrane Database Syst Rev 2017; 2:CD001100. Cheng S, Morrow DA, Sloan S, et al. Predictors of initial nontherapeutic anticoagulation with unfractionated heparin in ST-segment elevation myocardial infarction
Heparin is used to treat and prevent blood clots in the veins, arteries, or lung. Heparin is also used before surgery to reduce the risk of blood clots. 3. Heparin - the molecule heparin is heterogeneous of un branched polysaccharide chains Alternating monosaccaride units of L-iduronic acid and D-glucosamine one third of the polysaccharide. Hold infusion for 1 hour and decrease infusion by 2 units/kg/hr 6 hrs from the time the rate is decreased > 73 . Hold infusion and notify MD . Per MD order. When tPA is discontinued, discontinue Heparin Protocol for use During tPA Infusion. Initiate the High Dose heparin protocol with no initial bolus, refer to orders. Origin Date: 9/201
Heparin infusion starts approximately 4 to 6 hours post-surgical palliation or immediate post cardiac catheterization at 10 units/kg/hour. Since the intent is not to achieve therapeutic anti-coagulation, the dose is not changed. If there is concern that cumulative Heparin infusions ma For patients currently receiving intravenous heparin, stop intravenous infusion of heparin sodium immediately after administering the first dose of oral anticoagulant; or for intermittent intravenous administration of heparin sodium, start oral anticoagulant 0 to 2 hours before the time that the next dose of heparin was to have been administered When administered intravenously, heparin is ordered in units/hr or mL/hr. Usually, however, heparin is ordered on the basis of the units/hr when ordered intravenously and should be administered by an electronic infusion device. Heparin is available in single-dose and multidose vials, as well as in commercially prepared IV solutions
GUIDELINES FOR PRESCRIBING PARENTERAL HEPARIN INFUSION 1. Bolus dose: A loading dose of 75 units/kg iv UFH bolus should be given prior to starting infusion (rounded to nearest 100 units) unless baseline APTT ratio is >1.2 (discuss with haematologist) Date Time Bolus dose (75units/kg) Doctor signature Time given Nurs 5. The systemic heparin infusion of 25,000 units/250 mL D5W (or in 250 mL 0.45 % sodium chloride if D5W premixed infusion is unavailable) will be started at an initial combined (purge plus systemic heparin) rate of 12 units/kg/hr (based on actual body weight). In other words, the systemic heparin infusion will be started at a rat units of sodium heparin in 250 ml normal saline (0.9% sodium chloride) and are not suitable for infusional devices using higher concentrations. Therapy is usually initiated with a bolus intravenous dose of heparin calculated by body weight, and then a heparin infusion commenced at the rate indicated below
Heparin therapy may then be discontinued without tapering [see Drug Interactions (7.4)]. 2.7 Converting to Oral Anticoagulants other than Warfarin . For patients currently receiving intravenous heparin, stop intravenous infusion of heparin sodium immediately after administering the first dose of oral anticoagulant; or for intermitten 1 Give IV bolus 50units/kg, before recommencing at increased infusion rate.. 2 Stop infusion for 30 minutes before recommencing at reduced infusion rate.. 3 Stop infusion for 60 minutes before recommencing at reduced infusion rate # For ECMO - use Anti-Xa levels (target range 0.4 - 1) PROPHYLACTIC DOSE. This indication is unlicensed for use in children 1. Dr. Smith has ordered a heparin infusion of 1,000 units/hour (u/hr) for John Doe in bed 7. The infusion is to be mixed as 25,000 units (u) in 500 milliliters (mL) .9% NS. What rate will the IV pump be set to? In this example, Dose ordered = 1,000 u; Volume of dose available = 500 mL; Dose available = 25,000 Prophylactic-dose anticoagulation is generally recommended for acutely ill hospitalized patients. However, given the hemostatic abnormalities of severe COVID-19 illness, it is unknown whether more intensive anticoagulation is preferred to reduce the risk of thrombotic events, potentially mitigating microvascular and macrovascular thrombi and even disseminated intravascular coagulation (DIC)
Use only 1000 units / mL heparin infusion. Use 20 000 units / 20 mL ampoules. Do NOT dilute concentrated vials. The therapeutic range for heparin is an APTT ratio of 2 - 3. Check APTT ratio 6 hours after the heparin bolus, then adjust rate to achieve therapeutic range of 2 - 3 using the dose adjustment table Intravenous Heparin Therapy Adjustment Dose Stop infusion for 1 hour, then 8 units/kg/hr n/a Stop infusion for 1 hour, then 15 units/kg/hr aPTT Range 5 n/a (>3.0 x control) Max Dose 8,000 units 1,800 units/hr 4,000 units 1,000 units/hr Lab Test aPTT lab test should be performed 6 hours of dose adjustment. 16 units/kg/hr 20 units/kg/hr 22 units. IV: Use the following protocol for heparin infusion in the ICU ONLY (print an individualised heparin infusion protocol from the database). All doses are in units/kg and should be rounded to the nearest 100 units (note: 100 units equals 0.2ml when heparin is prepared according to the standard dilution above) UNFRACTIONATED HEPARIN DOSING NOMOGRAMS Dobesh References 1. Saya FG, Coleman LT, Martinoff JT.Pharmacist-directed heparin therapy using a standard dosing and monitoring protocol. Am J Hosp Pharm 1985;42:1965-9. 2. Hull RD, Raskob GE, Rosenbloom D, et al.Optimal therapeutic level of heparin therapy in patients with venous thrombosis Continuous IV infusion: Loading dose of 5,000 units and then 20,000-40,000 units/day. Mix well when adding heparin to IV infusion. Do not add heparin to infusion lines of other drugs, and do not piggyback other drugs into heparin line. If this must be done, ensure drug compatibility
administered by continuous IV infusion, both adjusted dose and ﬁxed dose SC injections can also be utilized. A com-parative study of SC and IV heparin using the same initial dose (5000 unit IV bolus followed by 30,000 units/day) reported an increased risk of VTE recurrence with SC heparin (19.3 % vs. 5.2 %; p = 0.024), suggesting th Intravenous unfractionated heparin (UFH) remains one of the most commonly used anticoagulants in the hospital setting. The optimal protocol for initiation and maintenance of UFH has been difficult to determine. Over the past two decades, weight-based nomogram protocols have gained favor. Herein, we present a retrospective study of 377 patients at a single tertiary academic center treated with. • Consider heparin at 10 units/kg/hr during alteplase infusion (do not give a heparin loading dose). Start as soon as possible, aiming for several hours of heparin prior to starting alteplase. If patient is already on therapeutic heparin, reduce the infusion rate to 10 units/kg/hr 30 minutes prior to starting alteplase Results of experimental studies in animals indicate that when the APTT response to heparin is blunted by infusion of procoagulants, dose escalation can be avoided without compromising efficacy, by.
Unfractionated heparin infusion for treatment of venous thromboembolism based on actual body weight without dose capping Julia A Shlensky, Kristina M Thurber, John G O'Meara, Narith N Ou, Jennifer L Osborn, Ross A Dierkhising, Kristin C Mara, Dennis M Bierle, and Paul R Daniel infusion safety system software datasets from more than 100 individual hospitals revealed huge variability in drug names, concentrations, dosing units, dose limits, maximum infusion rates, weight limits, volume limits, and other variables. 20. For example, in programming an infusion o
A weight-based intravenous bolus dose followed by a continuous infusion is preferred when a patient requires immediate and full anticoagulation (Table 1). 13 A relationship has been reported between the dose of UFH administered and both its efficacy and safety. 14,15 Thus, the dose of UFH must be adjusted by activated partial thromboplastin time (aPTT) or, when very high doses are given, by. If user-programming of infusion pumps is necessary, consider requiring an independent double check of all programming parameters (as well as verification of the patient, patient's weight, drug [concentration and dose rate], line attachment, and lab values upon which dosing is based) before administering heparin infusions Common Trade Names: Heparin; Adult Dosing. See University of Washington pharmacy heparin infusion guidelines; Thromboembolism. Bolus: 80 units/kg IV x 1 (MAX: 5,000 units) Then drip: 18 units/kg/h IV (MAX: 1,000 units/h) Adjust dose to target aPTT levels based on nomogram; Pediatric Dosing. IV infusion Initial loading dose 75 units/kg given.
IV Infusion Rate (cc/hr) = dose (mcg/kg/min) x weight (kg) x 60 min/hr concentration (mg/cc) x 1000 mcg/mg Created: Friday, December 28, 2001 Last Modified. Usual heparin bolus dose is 50-100 units/kg Once ACT drops to 300 seconds or below, initiate heparin infusion as ordered. Usual initial heparin infusion rate is 7.5-20 units/kg/hr Obtain ACT as ordered and adjust as indicated below *****NON-BLEEDING PATIENT***** ACT (seconds) Re -bolus Hold Infusion Rate Adjustmen Initiate heparin therapy: 1. Provide loading dose of 75 units/kg 2. Start heparin infusion at 30 units/kg/hour for neonates, 20 units/kg/hr for older children, and 13 units/kg/hr if >40 kg Collect the following labs 4 hours after heparin infusion initiation: 1. Anti-factor Xa level (ordered as Heparin-Unfractionated in EPIC View P and T_HHC_ Heparin Infusion Dosing Protocol_ HH.pdf from ECO 201 at Southern New Hampshire University. Title: Heparin Infusion Dosing Protocol Purpose: To define the dosing, adjustment an The frequency of low-dose heparin infusion was compared across various patient, hospital, and central venous catheter factors using chi-square, Mann-Whitney U, and Fisher exact tests. In the multivariate analysis, age was not a significant factor for low-dose heparin infusion use
In most patients weighing more than 220 lb (100 kg), high-dose heparin prophylaxis (7,500 units subcutaneously three times per day) does not further reduce the risk of VTE compared with standard. Adult: 75-80 U/kg or 5,000 U (10,000 U in severe pulmonary embolism) IV loading dose followed by 18 U/kg or 1,000-2,000 U/hr continuous infusion.Alternatively, intermittent inj of 5,000-10,000 U 4-6 hrly. Child: 50 U/kg loading dose, followed by an infusion of 15-25 U/kg/hr. Elderly: Lower dosages may be required Dosing: Adult. Note: Heparin may be given by continuous IV infusion or SubQ depending on the indication.For weight-based IV heparin, an institution-specific dosing nomogram may help to achieve therapeutic anticoagulation more rapidly (see example based on aPTT under Venous thromboembolism treatment).If unusually large doses of heparin are required to achieve therapeutic targets, consider.